title: Identifying women at risk for delayed presentation of breast cancer: a cross-sectional study in Estonia.
abstract: BACKGROUND
  Survival from breast cancer remains lower in Estonia than in most other European countries. More advanced stage and larger tumors that have impact on survival may be a result of delay in seeking help for breast cancer symptoms. The aim of this study was to identify determinants of delayed presentation among breast cancer patients in Estonia.
  
  
  METHODS
  The study population included women with primary breast cancer diagnosed in Estonia in 2008-2010. All data were collected using structured personal interviews carried out by trained nurses in the hospital setting. Only patients with self-discovered symptoms were included in this analysis. Patient delay was measured as time elapsing from symptom self-discovery to first medical consultation. The effect of different factors on the likelihood of prolonged delay (>90 days) was evaluated using logistic regression.
  
  
  RESULTS
  Among 703 eligible patients, median patient delay was 16 days (interquartile range 5-54 days). Seventeen percent of the patients had their first medical consultation more than three months after self-detection of symptoms. In multivariate analysis, the risk of prolonged delay was significantly associated with age 65 years and over (OR 2.27, 95% CI 1.23-4.20), current smoking (OR 2.09, 95% CI 1.21-3.61), symptoms other than painless breast lump or breast pain (OR 1.84, 95% CI 1.08-3.16), no history of mammograms (OR 1.83, 95% CI 1.13-2.95), having received no information on breast cancer during past year (OR 1.77, 95% CI 1.05-2.99), and previous benign breast problems (OR 1.65, 95% CI 1.01-2.67). Non-significant risk increase was seen with lower education.
  
  
  CONCLUSIONS
  This study provides evidence that factors associated with delayed presentation of breast cancer in Eastern Europe are similar to those observed in Western countries. The results suggest that educational messages to general population should aim at increasing awareness of "non-lump" symptoms of breast cancer and encouraging women of all ages to present in a timely manner. Women at risk for delayed presentation such as smokers and women with no history of mammograms could be identified in the primary care setting.
authors.affiliation: Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia. kaire.innos@tai.ee.
authors.forename: Kaire
authors.initials: K
authors.lastname: Innos
authors.forename: Peeter
authors.initials: P
authors.lastname: Padrik
authors.forename: Vahur
authors.initials: V
authors.lastname: Valvere
authors.forename: Evelyn
authors.initials: E
authors.lastname: Eelma
authors.forename: Riina
authors.initials: R
authors.lastname: Kütner
authors.forename: Jaak
authors.initials: J
authors.lastname: Lehtsaar
authors.forename: Mare
authors.initials: M
authors.lastname: Tekkel
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D004957:Estonia; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008327:Mammography; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D018570:Risk Assessment; D013997:Time Factors